From the Guidelines
Swaddling babies is not recommended as a strategy to reduce the risk of SIDS, and it may even increase the risk of death if the infant is placed in or rolls to the prone position. The most recent and highest quality study, published in 2016 in the journal Pediatrics 1, found that there is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. While swaddling may help calm infants and promote sleep, it also has several risks, including restricting chest movement and breathing, increasing the risk of hip dysplasia, and potentially causing overheating.
Some of the benefits of swaddling include:
- Reducing crying and improving sleep quality
- Providing comfort during painful procedures like vaccinations
- Supporting the recommended back sleeping position, which reduces SIDS risk
However, the risks of swaddling outweigh the benefits, and it is not recommended as a strategy to reduce the risk of SIDS. The risks of swaddling include:
- Restricting chest movement and breathing if done too tightly
- Increasing the risk of hip dysplasia by keeping legs straight and adducted
- Potentially causing overheating, especially when the head is covered or the infant has an infection
- Increasing the risk of death if the infant is placed in or rolls to the prone position
For safe sleep practices, it is recommended to:
- Use a firm sleep surface, such as a mattress in a safety-approved crib
- Keep the sleep environment free from soft objects and bedding
- Ensure the baby sleeps on their back
- Monitor for overheating and ensure the baby's head is uncovered
- Avoid using swaddling as a strategy to reduce the risk of SIDS, especially if the infant is placed in or rolls to the prone position.
From the Research
Evidence For Swaddling Babies
- Swaddling calms infants and promotes sleep 2
- Swaddling can soothe pain in infants and is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions 3
- Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled 3
- Swaddling can be helpful in regulating temperature 3
Evidence Against Swaddling Babies
- There may be a slight risk for sudden infant death syndrome associated with supine swaddling, although the impact of confounding variables is unclear 2
- Swaddling tightly around the hips is strongly associated with developmental dysplasia of the hip 2, 3
- The combination of swaddling with prone position increases the risk of sudden infant death syndrome 4, 3
- There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling 3
- Swaddling can cause hyperthermia when misapplied 3
- Swaddling may increase the risk of sudden infant death syndrome, especially if the infant is placed in a prone or side sleeping position 4, 5
- Decreased cortical arousals observed in infants unfamiliar with swaddling may correspond to the increased risk of sudden infant death syndrome for inexperienced prone sleepers 5